This application aims to provide information that may improve the quality of end-of-life care for older prisoners, a vulnerable population for which very little research has been conducted (Aday, 2003). The project builds upon pilot research conducted by the PI (L. Phillips) and her faculty mentor (R. Allen) at Hamilton Prison for the Aged and Infirmed (Hamilton A & I), the site proposed in the current application. Furthermore, the project addresses several priority issues identified by the Agency for Healthcare Research and Quality, including: end-of-life issues, the elderly, low-income, and minorities. The project offers numerous advantages over previous research, which has typically focused on the desire for hospice services and the feasibility of offering these services within a correctional setting. These advantages include: (1) use of Prospect Theory to guide our hypotheses and structural equation model, and (2) pilot data on several measures, providing a basis for comparison within the prison system. It is believed that "prisonization", the length of time spent in prison and the potential to die outside of prison following the completion of their sentence, will be influential in prisoners' treatment selection. This study also examines potential psychosocial factors (e.g., spirituality/religiousity, quality of life, death attitudes) that may influence treatment selection for [unreadable] prospective health conditions including Alzheimer's disease, emphysema, and cancer with pain. The results of this project will be used to inform healthcare policy within the correctional setting in Alabama and, potentially, to inform policy decisions for all correctional facilities. Knowledge of prisoners' treatment preferences and the factors that influence these preferences may help identify specific treatments such as palliative care that can reduce healthcare costs while improving prisoners' quality of life. We will recruit 164 older prisoners from Hamilton A & I in Hamilton, AL. Prisoners will be interviewed regarding prospective health conditions, spirituality/religousity, quality of life, and death attitudes in an interview that will last approximately sixty to ninety minutes. These data will then be analyzed using a MANOVA to determine what factors (e.g. race, prisonization) significantly influence treatment selection (testing the applicability of Prospect Theory) in the prison setting, and by constructing a structural equation model to explore the influence of psychosocial factors on treatment selection. [unreadable] [unreadable] [unreadable] [unreadable]